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Pullout strength of anterior spinal instrumentation: a product comparison of seven screws in calf vertebral bodies

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Abstract

A lot of new implant devices for spine surgery are coming onto the market, in which vertebral screws play a fundamental role. The new screws developed for surgery of spine deformities have to be compared to established systems. A biomechanical in vitro study was designed to assess the bone–screw interface fixation strength of seven different screws used for correction of scoliosis in spine surgery. The objectives of the current study were twofold: (1) to evaluate the initial strength at the bone–screw interface of newly developed vertebral screws (Universal Spine System II) compared to established systems (product comparison) and (2) to evaluate the influence of screw design, screw diameter, screw length and bone mineral density on pullout strength. Fifty-six calf vertebral bodies were instrumented with seven different screws (USS II anterior 8.0 mm, USS II posterior 6.2 mm, KASS 6.25 mm, USS II anterior 6.2 mm, USS II posterior 5.2 mm, USS 6.0 mm, USS 5.0 mm). Bone mineral density (BMD) was determined by quantitative computed tomography (QCT). Failure in axial pullout was tested using a displacement-controlled universal test machine. USS II anterior 8.0 mm showed higher pullout strength than all other screws. The difference constituted a tendency (P = 0.108) when compared to USS II posterior 6.2 mm (+19%) and was significant in comparison to the other screws (+30 to +55%, P < 0.002). USS II posterior 6.2 mm showed significantly higher pullout strength than USS 5.0 mm (+30%, P = 0.014). The other screws did not differ significantly in pullout strength. Pullout strength correlated significantly with BMD (P = 0.0015) and vertebral body width/screw length (P < 0.001). The newly developed screws for spine surgery (USS II) show higher pullout strength when compared to established systems. Screw design had no significant influence on pullout force in vertebral body screws, but outer diameter of the screw, screw length and BMD are good predictors of pullout resistance.

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Acknowledgments

The authors thank Synthes, Umkirch, Germany for their support in the performance of the study and providing their screws for the experiments. Study and investigation were conducted at the AO Research Institute, Clavadelerstrasse, 7270 Davos, Switzerland.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany

    Konrad Seller

  2. AO Research Institute (ARI), Clavadelerstrasse, 7270, Davos, Switzerland

    Dieter Wahl, Erich Schneider & Berend Linke

  3. Orthopaedic Department I, Hessing Foundation, Hessingstr. 17, 86199, Augsburg, Germany

    Alexander Wild

  4. Department of Orthopaedic Surgery, University of Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany

    Rüdiger Krauspe

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  1. Konrad Seller
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  2. Dieter Wahl
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Correspondence to Konrad Seller.

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Seller, K., Wahl, D., Wild, A. et al. Pullout strength of anterior spinal instrumentation: a product comparison of seven screws in calf vertebral bodies. Eur Spine J 16, 1047–1054 (2007). https://doi.org/10.1007/s00586-007-0307-0

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  • DOI: https://doi.org/10.1007/s00586-007-0307-0

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